Saturday, September 16, 2006

Hidden Side Effects (or what your doctor forgot to tell you)

Did anyone reading this blog know that when you have an IV during childbirth, you are at increased risk for Uterine Apnea? What, you ask, is Uterine Apnea? I can tell you, because I had it with my first delivery.

Uterine Apnea is when a woman's uterus bleeds excessively after childbirth. In my case, the OB that delivered Andrew called for blood, but was able to stop the flow with the drug oxytocin. I have a friend who also had Uterine Apnea, and she had to have a blood transfusion because she lost so much blood. She told me that after she delivered her first child, the doctor and nurses were all very concerned, but no one really told her what was going on. All the medical personnel left her room for a couple of minutes, and she could hear a dripping sound. It was her blood dripping onto the floor. Very scary.

I didn't think much about my uterine apnea. I was induced for being borderline for hypertension, and so I had to have an IV with pitocin in it. The OB who delivered me made it seem as though the apnea was just a normal complication of childbirth that some women face. It scared Elliott enough that when I suggested delivering at home for our later children, he was (and is) against it, just in case.

A few weeks ago I had my semi-monthly check-up for this pregnancy. I drank a whole bottle of water on the way to the OB's office, because I wanted to be able to give a urine sample with ease. At the office, I was told they needed to do a further blood test to finish my labs, because they hadn't gotten enough blood the last time I was in. I gave the blood just fine, and went to check out at the front desk, only to look down at my arm and find it spurting blood out through the band-aid and everywhere. It was a mess. The nurse that helped me clean up commented to one of her co-workers that I was a "well-hydrated woman".

That got me thinking... If being well hydrated could cause me to have trouble stopping bleeding after a needle prick, what would an IV of fluids for several hours do to me. At my last check-up, I asked the doctor if he thought the IV could have caused my uterine apnea. He said definitely.

The question I ask is... Why hadn't I ever heard of this risk before? I have been to different types of child birth classes, and also read about the different types of pain management techniques available. Never once did any of these materials mention that if you have an IV, whether for pitocin or for an epidural, you are at increased risk of having uterine apnea. In fact, much of the literature I read about epidurals makes them sound like the safest drug in the world.

I definitely want women to have a good birth experience. If a woman thinks she can't handle the pain of labor, I don't necessarily have a problem with her getting an epidural, but I wish women were better informed about the side effects of what they choose to do medically.

My philosophy has always been, "You can always get more invasive, but you can never get less invasive." IMHO, it is better to go into labor thinking you will be as natural as possible, and if something happens that requires the woman to need the doctor to intervene, that is fine, but having the idea in one's head that there are no side-effects from pumping drugs of any kind into one's body is crazy. Not to mention that I have had several friends who thought they would show up at the hospital and get an epidural, only to be told that they were too far along, or the epidural didn't seem to do them any good. (You should hear their birth stories... They were very unprepared to deal with the pain of childbirth!)

Before Andrew was born, I decided I wanted to have an unmedicated childbirth. I tried to educate myself as to what types of pain management (both unmedicated, and medicated) were available, so that I would know if the decision had to be made, what would be right for me. I also tried to learn more about c-sections, in case that was warranted. I wish more women would educate themselves before labor, rather than relying on what their particular doctor's philosophy is.

Another example of unknown side-effects occurred after Emma was born. I was given Percocet to help with the pain of post-partum contractions after Emma was born. A little while after taking it, I began to be extremely groggy, and really thirsty. I really could barely keep my eyes open, and literally drank a whole pitcher full of water without having my thirst satisfied. I rang the bell to have the nurse bring me more water. Instead of my regular nurse, a different nurse answered the bell, and when I told her what was happening, she instantly accused me of not drinking enough, asked me where my IV was, and threatened to put me on an IV if I kept being dehydrated. I hadn't just gone through natural childbirth, with no IV, only to be told I was going to have one put in afterall.

"Hmmm," I thought to myself, "I guess I won't tell you when I am thirsty again!"

After a few hours, I began to feel better, but I was given more percocet to help with the contraction pain. About half an hour later, I started having the same grogginess and dehydration again. I am not a rocket scientist, but it didn't take much for me to figure out that I was actually having an adverse reaction to the percocet. I called for the nurse again (this time my regular and wonderful nurse came), and told her what was happening, and that I thought it was a side-effect. Sure enough, she confirmed that it was. I admit to being a little bit irritated that I had not been told ahead of time what the side-effects of percocet are. I realized then that I needed to be even more proactive in asking what the side effects are of anything ever done to or given to me or my family.

I guess the point of this blog is to say... Educate yourself before you have a medical procedure done. So many times there are routine procedures that we have heard about, and that doctors perform, and we forget that even routine procedures have side effects. It is important to know what is going on with your body, and to get accurate descriptions of what is happening, not only from your doctor, but also from other sources so you have a well rounded knowledge.

Okay, off my soapbox!


Elizabeth said...

That's scary. Good to know.

Neal said...

I think the term you mean is uterine "atony," and it is one possible cause of post-partum hemorrhage, not the term for the hemorrhaging itself. Basically it's when the uterus is unable to contract and therefore unable to stop the blood flow after delivery. There are multiple causes: the only one I could find that might even possibly be linked to an IV would be over hydration causing expansion of the amniotic fluid and resulting in atony. And that was my own assumption, not anything I could verify. However, nowhere could I find an IV listed as a risk factor for uterine atony. The more probable cause in your case was that you were induced and received pitocin. These are recognized risk factors. Having an IV is a very important part of any procedure that could result in complications. It can be much more difficult or even impossible to start an IV in an emergency situation, when parenteral access is imperative. Also, you are much more likely to have complications from being dehydrated as opposed to becoming over hydrated by the IV, especially in a case where you have high blood pressure. Let me just say that I agree that it is vital to be informed of the risks of any medical procedure you may undergo, or drug you may take. That being said, it is also vital that the information you use to make your decision comes from a source that is both credible and reliable. Unfortunately, pregnancy and childbirth are two subjects about which there is a wealth of unreliable information. I also think it’s important to know your own limitations when it comes to your knowledge and understanding of physiology, anatomy, pharmacology, etc. Sometimes you have to trust your physician, who has a much greater knowledge in these fields. From the tone of your post, it does seem to me that you don’t trust doctors, or that their trying to withhold information from you (see title of post!). Everything has risks and benefits. You have to decide whether you think the benefits outweigh the risks. I think that’s what you’re saying too.

Ginger said...

Hey Neal- you got me all excited that you ahd a blog now... but you don't... Come on , join the fun in all your spare time! :-)

I DO trust doctors (well, it depends on the doctor), but I think my SIL Jenny summed up my feelings very well.... hope she doesn't mind me quoting her here...

"Doctors are regular people and they make mistakes, and assumptions, and they have to be careful of malpractice. They see things every day and might assume those things aren't a big deal, but when you're the person it's happening to, it IS a big deal. Then some doctors are lazy, like some people are lazy, some aren't current, some don't listen . . . and on and on. My friend, Kim, was told by a doctor at the beginning of her 2nd pregnancy that she just had big babies (she'd had 1) and she'd never be able to have a vaginal birth. Luckily she went to a different doctor and safely delivered a normal sized baby vaginally."

It is very important to find a doctor one trusts and believes knows their "stuff" so to speak, and also to be informed on their own, with thorough research

Neal said...

Of course having initials behind your name don't automatically make you a good doctor, dentist, etc. I couldn't agree more. I think it's important to seek out providers that you feel are competent, and then trust thier judgement after you have done any research you feel is necessary. My point is that you (not you personally, but you collectively) may not have all of the information correct and therefore create a perceived risk where one does not exist. This comes from lack of understanding or from faulty information. A perceived risk can be just as dangerous as a true risk because it can cause you to decline to have a procedure done that would be otherwise be beneficial and not risky. I think this applies to the case of not wanting an IV placed because of a perceived risk that it will lead to uterine atony.

Neal said...

Oh yeah, Leslie created a profile for me a couple of months ago but I haven't gotten around to making a blog. Audrey and Parker are always begging me to make one. I just don't want to start one and then never post!

Ginger said...

The reason I don't want an IV is I don't like needles! Anyway, there are plenty of women who have natural births and do just fine. If a woman is considered high risk, I think it is appropriate to get an IV, but I have talked to several OB's about not having an IV... all agree that it is a precaution, but not a necessary one. Hopefully, as with Emma, I won't be at the hospital long enough before she comes to even get the blood tests done!

Thank goodness for modern medicine!

tara said...

I posted earlier... but blogger wigged out on me, as is usually my luck with blogger... I was just saying that I really apprciated the diologue and comments in this post. Decisions surrounding childbirth are something that I, and I think most women who are having/have had babies can get pretty passionate about. Especially when something doesn't go as expected, and you feel that something could have been done to make it different or prevent the situation. Hind sight is always 20/20, right? Having now had 2 babies (c-sec) and one on the way I am feeling more and more the need to be reliant on Heavenly Father, and trust that I am in his care. I think I may need to post about this (=

tara said...

And I also forgot to say... congrats on the baby count down... that was the last thing I said on my post that got lost in cyberspace!

The Queen said...

Of course the other option is to drink enough water so that you aren't dehydrated, and to have a hep-lock so that in an emergency you can have an IV in promptly. My problem with the OB's that I have dealt with (and there have been several as each time I have delivered it has been with a practice of docs) is that so many times they will only tell you the risks of not going along with what they want. I realize that a big factor in much of their thinking must be fear of a lawsuit should something go wrong. However some of it is just ridiculous. Like the doctor who, after I told him I didn't want an episiotomy, proceeded to tell me about the patient who had declined one and then ended up looking like "hambuger meat" because of the horrible tearing that she had. Well I am pretty sure that in all of his years of practice he has also most likely had a woman on whom he perfomed an episiotomy and then she tore badly anyway. But was that discussed? No. Instead he should have said to me that he could help me avoid an episiotomy and tearing through controlled pushing during the last stage of labor. This is just one example of what irritates me so much about OB doctors. Something else that really bothers me is when there are so many "emergency c-sections". I shouldn't take up so much of your space here... Maybe I will continue this rant on my own blog... : )

Anonymous said...

what a great post and commentary! i wholeheartedly agree with being well-armed with information and preparation. with my first, i felt well-armed and ended up in a bit of a sticky situation. with my second baby, i took the best piece of pregnancy/childbirth advice i have ever received: ask the doctor for a copy of his standing orders. check them out, see what you might like changed, talk to him about it.

in my case, my doctor just asked me to make a birthplan and drafted a unique set of orders based upon it. it was AWESOME. no one hassled me about an iv, medication, eating and drinking in labor, or anything else i didn't care for. it was a great birth experience and i delivered a 10.5 pound baby without incident. well, except for the bleeding...

i'm a postpartum hemorrhager. last time was pretty bad, but was managed. i'm pregnant again and because of the birth climate where we now live, we are doing a homebirth with a cnm. my husband's only concern with a hb has been the hemorrhaging. we found a midwife with a lot of experience with it and who is well-armed with prenatal ways to prevent a bad outcome and who is willing to work with us on the rest. we're very excited! congrats on your impending babe!